In the introductory manuscript of this 2-part series, critical issues facing higher education in general, and veterinary medicine specifically, were examined. In addition, the historical perspective of the traditional approach to teaching was overviewed (1). The purpose of this article is to examine the lecture and laboratory, including the clinical laboratory, as instructional methologies. An additional purpose is to assess the potential of the lecture and laboratory, and assess how much of the potential is actually achieved.

Traditional Instructional Methodology: The Lecture

In the 1991 Ashe-Eric monograph Active Learning: Creating Excitement in the Classroom (2), Bonwell and Eison examine traditional approaches (lecture and laboratory) and alternative approaches (active learning). In discussing these approaches, Bonwell and Eison suggest that the method chosen should be viewed as appropriate or inappropriate only when placed within a context that considers objectives, complexity of subject matter, physical setting of the classroom, and capabilities of the learner (2). It is interesting to contemplate on veterinary faculty preparation for a teaching career. Most faculty have been through a discipline-based post-DVM educational program such as a residency or a PhD program, or perhaps both. The majority of faculty have not had any courses in education during their post-DVM educational programs, yet instruction is the major component of these faculty's appointment. Thus in the absence of knowing any different, we teach the way we were taught using our own role models as examples. The following quotation appears in Bonwell and Eison's monograph, and is in response to a professor being asked why he lectures:

"It is a tradition. It was part of my training, and seems like what I should be doing. I feel somehow guilty when I am not lecturing." (3)

Chism et al. and others noted a number of strengths of the lecture/lecturer (4, 5):

Lectures can communicate the intrinsic interest of the subject matter.

Lectures can hinder learning by placing the student in a passive role.

Lectures lack feedback to both the instructor and the student.

Lectures require an effective speaker.

Lectures place the burden of organizing and synthesizing content solely on the lecturer.

Lectures are not suited to complex, detailed or abstract material.

Lectures also fail to:

Teach students where to search for new material.

Show students that knowledge is constantly changing.

Provide access to data bases that students can manipulate to find new information.

Teach students how to solve problems through content application.

Teach students how to work cooperatively with others to solve problems.

Research suggests that the exclusive use of the lecture in the classroom constrains student learning (2). One of the problems with total reliance on the lecture method is the inability of most individuals to listen effectively over a sustained period, no matter how skillful a lecturer may be (2, 4). In a medical school study, student concentration in a lecture rose sharply to reach a maximum intensity in 10-15 minutes, and fell steadily thereafter (6). The authors suggested that the progressive fall in concentration may reflect saturation with factual data, partial exhaustion of teacher and students, student boredom, or lack of variety in the teaching method. It was suggested that a 25-30 minute lecture may be more appropriate than the conventional 50 minutes (6). In another study of concentration during a lecture, it was found that students noted 41% of the material presented during the first 15 minutes, and the amount noted decreased thereafter (7).

The lecture assumes that all students need the same information, presented orally, at the same pace, without dialogue with the presenter (4, 8). Clearly this assumption is invalid. In addition, the lecture assumes that students are auditory learners, have high memory capacity, have good note-taking skills, and are not susceptible to information processing overload (8). Lectures involve a passive approach to learning, and are largely out of control of the student (5). Student surveys find teaching to be too uniformly didactic, and their learning too passive (9). Students report spending considerable class time just taking notes. In addition, much study time is spent just memorizing rather than in activities such as analysis, application, synthesis, and evaluation (9). There is ample evidence that lectures are less popular than other methods of instruction (10). In a review of multidisciplinary research (including the biological sciences) comparing lectures vs. discussion, student-centered projects, reading, and self-instruction, Costin makes the following conclusions (11): Lectures do not differ consistently from discussion or student-centered projects in acquisition of information. Discussion is probably more effective for teaching cognitive skills: interpreting knowledge and solving problems. Discussion and student-centered projects are more effective for helping students retain information beyond the termination of a course. For lectures vs. reading and self-instruction, there is no clear-cut superiority of any one method over the other. If any advantage exists, it may be in the direction of self-instruction. In an extensive review of the literature on the lecture, Bligh makes observations and conclusions similar to those of Costin (10). In addition, Bligh studied attitudinal objectives of learning: interest in the subject, promotion of thought, acquisition of values associated with the subject, and personality development. Compared to active methods such as discussion, lectures are less effective in generating enthusiasm/interest in a subject, are relatively ineffective in stimulating thought, and are ineffective in changing values. Because the lecture places the student in a relatively passive mode, the lecture is not appropriate to develop a student's personality, social responsiveness, or self-awareness (10). Expecting the lecture to develop these attributes is compared with the expectation of adjusting prisoners to society by putting them in solitary confinement (10).

In a recent commentary on teaching veterinary students, the authors refer to negative influences of teaching, including overt and covert abuse (12). What potential does the lecture have to cause abuse, at least covert? Traditionally, health professions students are deluged with facts in lectures, and must memorize the facts in order to pass tests that require only the lowest order of cognitive skills (13-16). Is this a form of abuse? Could this explain why, at least in medical students, cynicism increases throughout the educational years (17)? In a report of 10 years of learner-centered problem-based learning at the University of New Mexico School of Medicine, one of the issues addressed was the setting that led to the change in instructional methodology. The existing educational environment was questioned as to its ability to produce a caring physician. The following was quoted: "I wanted to be more human and not lose touch with my friends. But look what I've become--a drone. I sit in one class after another."(18)

To summarize, evidence suggests that if an instructor's goals are not only to impart information but also to develop cognitive skills and change attitudes, then alternative teaching strategies should be interwoven with the lecture methods during classroom presentations (2). Hence, the findings of Costin, Bligh and others provide a stimulus for veterinary faculty to critically examine the current emphasis placed on lectures during the first three years of the curriculum. The issue is of heightened importance at a time when veterinary educators are being challenged to move student learning away from acquisition of facts towards finding information and solving problems (19).

Traditional Instructional Methodology: The Laboratory

Laboratory instruction has been criticized because the laboratory gives a false impression of how science is carried out, and how problems are solved (5). An artificial constraint within the laboratory is the need for students to work on a set of exercises within a limited time period. It is believed that too much emphasis is placed on getting the correct result rather than on the process of investigation (5). McConnell, who returned to the classroom to study medicine, expressed concern about the frequent failure of instructors to be aware of the real learning processes at work in the laboratory, as well as the discrepancy between the learning that takes place and the instructional aims for practical classes (20).

A challenge of clinical education of medical students, and by analogy veterinary students, is to transform novice students into practicing clinicians (21). Students are helped to learn data collection, interpretation and synthesis of findings, critical evaluation of actions taken, skillful performance of procedures, and establishment of ethical and caring relationships with patients (21). Clinical teaching should produce students capable of practicing both the art and the science of medicine. In the article "Clinical Teaching and the Clinical Teacher," Irby identifies four "glaring" problem areas in medical education (21). These problems are similar if not identical to problems in veterinary medical education, and include limited emphasis on problem solving, lack of clear expectations for student performance, inadequate feedback to students, and inappropriate role models and clinical settings (21).

Problem solving. While the clinical setting is ideal is ideal for problem solving, there is insufficient time for students to reflect on their learning, make connections to basic science information, restructure existing knowledge, and engage in real problem solving (21). Eichna, another physician who returned to medical school noted that the clinical years perpetuate nonthinking, and that inordinate amounts of time are spent in mechanical "doing." He also states "fatigue, somatic and cerebral, dulls the will and the edge of thought."(22) Rounds present an ideal opportunity for problem solving. Yet concurrent demands of students, patients, clients, consulting and referring veterinarians too frequently result in rounds just being used for updates of patient status.

Lack of clear expectations and inadequate feedback. Diversity of cases and different educational experiences of students on clinical rotations (21) make clear expectations difficult to establish. Positive feedback appears to be universally insufficient, and negative feedback may be avoided because it is potentially confrontive. Lack of time is another factor in lack of feedback.

Role models. The role modeling process demonstrates the knowledge, skills, attitudes, and ethical behaviors that students should acquire (21). How successful are clinical faculty in exemplifying all these attributes?

In a recent study of veterinary clinical teaching, Fossum et al. identified similar issues in veterinary education (23). Some clinical faculty believe that because problems are dealt with in clinics, it follows that clinical teaching is essentially problem-based teaching (23). Instead, there is a notable tendency for clinical faculty to follow a more traditional content-driven, or subject-based, nonproblem-solving approach. The authors of the study refer to a classification by Schon of different types of teacher-student relationships in the clinical setting (24). In the first type, knowledge is seen in terms of facts, rules, and procedures. The instructor's role is to communicate and demonstrate the application or rules by observing student performance, detecting errors, and pointing out correct responses (24). In the second type, "reflection in action," the student still learns the relevant facts but also learns rules of inquiry: it is presumed there is a right answer for every situation. The third type is also reflection in action, but it is assumed neither that existing knowledge fits every case, nor that every problem has a right answer. In the third type, new methods of reasoning, new strategies of action, and new ways of framing problems are developed (24). In the above veterinary study, observations of clinicians indicated that some interactions between students and clinicians fit the technical training situation, and very few instances of teaching generated reflective learning (23). The implications mentioned by the authors of the study are that "if colleges of veterinary medicine are to produce competent practitioners, the colleges must provide the opportunity for students to acquire the ability to reflect on their actions in such a way as to be able to solve unique problems for which there may be no single correct answer." (23) Reflective teaching requires that students have time, usually in small groups, to verbally think through what they have done under the guidance of an experienced group leader.

Going beyond the traditional lecture and laboratory, we start to recognize that we cannot do the same thing for all learners without a loss of communicative ability and therefore a partial failure to transmit information. One variable upon which students differ is their learning style.

Learning Styles

Learning styles refer generally to the preferred ways in which students acquire or approach new cognitive/affective material in a learning setting. A number of learning style models have been identified by Claxton and Murrel in their recent Ashe-Eric monograph Learning Styles: Implications for Improving Education Practices (25). The learning style models relate to personality, information processing style, social interaction patterns, and instructional preference models. Aspects of two of these models, personality and information processing, will be addressed in this article. For an in-depth review of learning style models, the above monograph is recommended.

One of the personality models is assessed by the Myers Briggs Type Indicator (MBTI) (25). The model considers the different ways people take in information (their perception), and the way they make decisions (their judging functions). The MBTI provides information on how students process in 4 dimensions (internally or externally, intuitive or sensory, thinking or feeling, and perceiving or judging). Each individual receives a profile specifying how they process in each dimension. These dimensions are all critical to the assignment of appropriate learning methodologies. The MBTI is useful for promoting dialogue with students about how they learn. In the process, faculty can become more sensitive to the consequences of the match or mismatch with students in their classes (25). Personality models, including the MBTI, have been described in the veterinary literature (26, 27).

Information processing approaches deal with the way people process information. In 1981, Schmeck identified two learning approaches in terms of how people process information: "deep elaborative" information processors, and "shallow reiterative" information processors (28). Most students will be oriented towards the deep or shallow approach at different times, depending on discipline and on teaching received (29). Deep elaborative information processors "classify, contrast, analyze, and synthesize information from different sources. They elaborate by thinking of personal examples, visually imaging personal illustrations, and restating information in their own words. They draw upon the depth and breadth of their experiences ." (28) Deep elaborative students demonstrate faster learning, better memory, and higher grade point averages than the shallow reiterative students (28). In contrast, the shallow reiterative information processors "spend much of their study time repeating and memorizing information in its original form. They prefer to assimilate information as given rather than rewording, restating, or rethinking it." (28) For those individuals, the material is to be impressed on the memory for a limited period, with the specific intention of satisfying external demands, for example, an examination. There is no expectation that the material will be part of the students cognitive structure (29).

In disciplines such as the sciences, the deep approach may involved considerable emphasis on detail and procedures, and may even require a preliminary stage of rote learning (29). This is certainly true in veterinary medicine where "veterinary literacy" involves memorization of a certain amount of factual material. Unless the material is inherently interesting, or unless it is quickly used, it will be treated as shallow reiterative by the students.

We believe that traditional teaching methodologies in the first 3 years of the veterinary curriculum have fostered a "shallow" approach to learning. It is anticipated that there will be a gradual move from accumulating facts to finding and using information. Tests are a major vehicle for shaping student learning styles (28). If testing demands regurgitation, shallow reiterative memorization is encouraged, whereas testing for comprehension of meaning encourages deeper, more elaborative and thoughtful information processing (28). As veterinary faculty move from regurgitation type of tests to those that call for understanding and applying concepts (for example, case-based questions), a gradual move from the shallow to the deep approach can be expected. It is necessary for faculty to be as insightful as possible concerning students' style and development stage. For students who can focus only on memorization, faculty need to provide activities that stimulate students to deeper thinking in a manner that their integrity is respected (25).

Summary

This article addresses the traditional lecture and laboratory, with emphasis on their constraints. An attempt is made to provide a brief overview of certain learning style models, with emphasis on the desirability to provide instruction in a manner that facilitates "deep elaborative thinking" in veterinary students. It is hoped that faculty who are considering changes in instructional methodology will have a more informed basis to consider change.